Predictive and prognostic value of serum AFP level and its dynamic changes in advanced gastric cancer patients with elevated serum AFP

Table 1 Univariate prognostic analysis of clinicopathological features n (%)

Variable	AFPAGC(n = 105)	Median OS (mo)	P value
Sex
Male	82 (78.1)	15.0	0.144
Female	23 (21.9)	11.3
Age (yr)
≥ 60	49 (46.7)	15.0	0.189
< 60	56 (53.3)	12.0
Serum AFP level (ng/mL)
≥ 500	37 (35.2)	13.0	0.806
< 500	68 (64.5)	14.6
Primary lesion site
EGJ	41 (39.8)	15.0	0.245
Non-EGJ	62 (60.2)	12.0
Differentiation degree
Well	30 (29.4)	15.4	0.496
Poor	66 (64.7)	12.9
HAS	6 (5.9)	4.5
Lauren classification
Intestinal	45 (57.0)	15.4	0.352
Non-intestinal	34 (43.0)	14.6
HER2 status
Positive	20 (24.4)	17.5	0.583
Negative	62 (75.6)	14.6
LM
Present	63 (60.0)	12.0	0.048a
Absent	42 (40.0)	16.7
Peritoneal metastasis
Present	16 (15.4)	6.17	0.001a
Absent	88 (84.6)	15.2
Non-regional LNM
Present	56 (53.3)	11.0	0.042a
Absent	49 (46.7)	17.9
Other hematogenous metastasis
Present	27 (25.7)	10.5	0.004a
Absent	78 (74.3)	17.5
PVTT
Present	13 (12.4)	8.3	0.011a
Absent	92 (87.6)	15.0
First-line regimen
Doublet regimen	89 (88.1)	14.6	0.850
Triplet regimen	12 (11.9)	15.1
Evaluation
PR	42 (48.3)	17.6	0.007a
SD + PD	45 (51.7)	11.1
AFP decline degree
≥ 50%	49 (55.7)	17.5	0.003a
< 50%	39 (44.3)	10.0
Local treatment for LM
Yes	19 (18.1)	17.9	0.215
No	86 (81.9)	12.9

^aP < 0.05. GEJ: Gastroesophageal junction; HER2: Human epidermal growth factor receptor-2; AFP: α-fetoprotein; LM: Liver metastasis; LNM: Lymph node metastasis; PVTT: Portal vein tumor thrombus.

Table 2 Comparison of objective response rates to different chemotherapy regimens n (%)

Regimen	Platinum-based doublet regimen(n = 58)	Taxane-based doublet regimen(n = 17)	Triplet regimen(n =11)	P value
Overall population				0.201
PR	31 (53.4)	5 (29.4)	6 (54.5)
SD + PD	27 (46.6)	12 (76.4)	5 (45.5)
AFP ≥ 160 ng/mL				0.067
PR	10 (32.3)	0 (0.0)	4 (57.1)
SD + PD	21 (67.7)	7 (100.0)	3 (42.9)
AFP < 160 ng/mL				0.193
PR	21 (77.8)	5 (50.0)	2 (50.0)
SD + PD	6 (22.2)	5 (50.0)	2 (50.0)

PR: Partial response; SD: Stable disease; PD: Progressive disease.

Table 3 Severe adverse events of different chemotherapy regimens n (%)

Regimen	Platinum-based doublet regimen(n = 72)	Taxane-based doublet regimen(n = 17)	Triplet regimen(n =12)	P value
≥ G3 AEs	11 (15.3)	4 (23.5)	7 (58.3)	0.004

AEs: Adverse events.

Table 4 Comparison of response, liver metastasis rate, and overall survival between alpha-fetoprotein ≥ 160 ng/mL and alpha-fetoprotein < 160 ng/mL groups n (%)

Variable	AFP ≥ 160 ng/mL	AFP < 160 ng/mL	P value
Overall ORR
PR	14 (30.4)	28 (68.3)	< 0.001a
SD + PD	32 (69.6)	13 (31.7)
ORR to doublet regimens
PR	10 (26.3)	26 (70.3)	< 0.001a
SD + PD	28 (73.7)	11 (30.7)
ORR to triplet regimens
PR	4 (57.1)	2 (50.0)	0.652
SD + PD	3 (42.9)	2 (50.0)
Liver metastasis rate	69.8%	50.0%	0.030a
Median OS	13.0 mo	14.8 mo	0.712

^aP < 0.05. PR: Partial response; SD: Stable disease; PD: Progressive disease; ORR: Objective response rate; OS: Overall survival.

Table 5 Correlation between decline degree of serum alpha-fetoprotein and response n (%)

Variable	AFP decline ≥ 50%	AFP decline < 50%	P value
Response
PR	34 (72.3)	5 (14.7)	<0.001
SD + PD	13 (27.7)	29 (85.3)

SD: Stable disease; PD: Progressive disease; OS: Overall survival; PR: Partial response

Table 6 Multiple Cox regression analysis of prognostic factors

Factor	HR	95%CI	P value
LM (present)	2.809	1.363-5.788	0.005a
PM (present)	4.243	2.026-8.883	< 0.001a
Non-regional LNM (present)	3.743	1.928-7.268	< 0.001a
Other hematogenous metastasis (present)	1.479	0.692-3.161	0.312
PVTT (present)	2.341	1.030-5.320	0.048a
Response (SD + PD)	1.92	0.953-3.867	0.068
AFP decline degree (< 50%)	1.876	0.980-3.589	0.057

^aP value < 0.05. LM: Liver metastasis; PM: Peritoneal metastasis; LNM: Lymph node metastasis; PVTT: Portal vein tumor thrombus; SD: Stable disease; PD: Progressive disease; HR: Hazard ratio.